Mid-term

Question 1

F&E: what is crucial to the maintenance of homeostasis?

Answer 1

regulation of the concentration of oxygen, carbon dioxide, organic nutrients, wastes and inorganic ions

Question 2

F&E: intracellular components

Answer 2

40% total body weight

most found in skeletal muscle cells

Question 3

F&E: extracellular components

Answer 3

20% total body weight
compartments: interstitial [cells outside vessels], intravascular [cells w/i the blood vessel], transcellular [cells everywhere else]

Question 4

F&E: 1 L of water= ___ lbs=___ kg

Answer 4

2.2
1
this allows for fluid loss/gain to be monitored via weight change

Question 5

F&E: Na+

Answer 5

sodium
135-145 mEq/L
for fluid retention, neuromuscular and enzymatic functioning

Question 6

F&E: Cl-

Answer 6

chloride
96-106 mEq/L
works w/ Na to provide hydration with a role in hydrochloric acid

Question 7

F&E: K+

Answer 7

potassium
3.5-5.0 mEq/L
for contraction of muscles [esp/ heart muscles]

Question 8

F&E: Ca+

Answer 8

calcium
8.6-10.2 mg/dL
most abundant mineral in the body
for muscle contraction, blood coagulation, and bone structure [as 99% of Ca+ is stored in the bones]

Question 9

F&E: PO4-

Answer 9

phosphorous
2.4-4.4 mg/dL
combined w/ Ca+ in the crystals of bones and teeth
2nd most abundant mineral in the body
for acid-base balance as a buffer [phosphoric acid]

Question 10

F&E: Mg+

Answer 10

magnesium
1.5-2.5 mEq/L
for neuromuscular functioning

Question 11

F&E: HCO3

Answer 11

bicarbonate
22-26 mEq/L
for acid-base regulation

Question 12

F&E: hydrostatic pressure

Answer 12

influenced by blood pressure and volume
arteries have a high hydrostatic pressure
it pushes fluid out of the vessel into the interstitial space
as it leaves, the H.P. decreases
as the H.P. decreases, it will fall below the colloidal osmotic pressure

Question 13

F&E: colloidal osmotic pressure

Answer 13

exerted by plasma proteins
once the fluid is in the interstitial areas and the hydrostatic pressure is decreased, blood draws back into the vessels to be brought back into the heart
- at this point the O-carrying blood has perfused O to the tissue, so it enters the bloodstream to get oxygenated once more
in cases of malnutrition, the colloidal osmotic pressure couldn’t do its purpose in bringing blood back into the vessels b/c of the lack of essential plasma proteins

Question 14

F&E: how much urine should be excreted?

Answer 14

1-2 mL/kg/hr

Question 15

F&E: protein deficiency

Answer 15

causes: inadequate protein intake, protein loss, decreased protein synthesis
s/s: poor wound healing, edema [disturbance in colloidal osmotic pressure], anemia [protein carries O], fatigue, weight loss, muscle wasting [builds up muscle]
tx: diet high in amino acids, CHO [CHO used for energy leaving protein to be used for muscle gain and not energy] and protein

Question 16

F&E: plasma-to-interstitial fluid shift

Answer 16

fluid shift from vascular compartment to interstitial compartment
causes: increased capillary hydrostatic pressure, decreased plasma protein, increased capillary permeability
s/s: increased heart rate [decrease in blood volume makes heart work harder to get blood to the major organs], decrease in B.P., decrease urine output, edema
tx: replace F and E, cautiously

Question 17

F&E: types of edema

Answer 17

pitting
dependent
- upon gravity and position
weeping
- fluid seeps out through the skin
anascara
- edema throughout the body
other
- edema of a specific system [i.e. ascites, pleural effusion]

Question 18

F&E: interstitial-to-plasma fluid shift

Answer 18

shift of fluid from interstitial to intravascular compartment
causes: decrease in capillary hydrostatic pressure, increases in colloidal osmotic pressure, remobilization of fluid following burns and trauma
s/s: increased B.P., large amounts of diluted urine, bounding heart beats, pleural edema, restlessness [2o to pleural edema]
tx: fluid is excreted naturally is pt. has healthy heart and kidneys, if not, use of diuretics or dialysis may be needed

Question 19

F&E: what are primary and secondary sx of respiratory distress?

Answer 19

primary
- restlessness>increased heart rate
secondary
- crackles in the lungs, altered mental status, drop in pulse ox., use of accessory muscles

Question 20

F&E: hyper-osmolarity

Answer 20

too many particles [of Na] or too little water which results in cell-shrinking
causes: decreased water intake, extracellular solute excess
s/s: dehydration [evidenced by increase in heart rate, thirst, poor skin turgor, dry mucous membranes/skin, decreased/concentrated urine], cell shrinkage [evidenced by altered mental status]
tx: replace water [PO or IV]

Question 21

F&E: hypo-osmolarity

Answer 21

or water intoxication
too few particles or too much water which results in cell swelling
causes: replacing H2O and Na loss w/ only H2O, inability to excrete urine [seen in chronic renaal failure]
s/s: cerebral edema, diluted urine, increased B.P.
tx: replace loss w/ Na ad H2O [isotonic solution], utilize oral liquids w/ electrolytes

Question 22

F&E: isotonic deficit

Answer 22

Na and H2O loss in equal proportions which do not cause size change in cells but decreases the volume of the ECF
tx: treat underlying cause, administer isotonic solution, carefully

Question 23

F&E: what are s/s of hemorrhaging?

Answer 23

increase in heart rate, altered mental status, hypoxia, decrease in urine output

Question 24

F&E: isotonic excess

Answer 24

Na and H2O gain in equal proportions which do not cause size change in cells but increases the volume of the ECF
s/s: pulmonary edema [causing restlessness, tachycardia, crackles in the lungs]
tx: restrict fluids, monitor fluids, diuretics/dialysis

Question 25

F&E: hypernatremia

Answer 25

an excess of Na s/s: results from cell shrinkage and fluid shifting [i.e. brain cell shrinkage causing altered mental status] tx: restrict Na intake, gradual lowering of Na to prevent cerebral edema, monitor changes in behavior

Question 26

F&E: hyponatremia

Answer 26

a deficit of Na s/s: cerebral edema, diluted urine, increased B.P. tx: isotonic or hypertonic solution, restriction of water

Question 27

F&E: hyperkalemia

Answer 27

an excess of K causes: pseudohyperkalemia, chronic renal failure, use of salt substitutes [major ingredient: K], K sparing diuretics, metabolic acidosis, burns [destroy K-containing blood cells] tx: K-restricted diet, calcium gluconate [does not affect K levels, used for cardiac arrhythmia's, dialysis, med.'s to reduce K [i.e. kayexalate]

Question 28

F&E: pseudohyperkalemia

Answer 28

this occurs during a blood draw where the syringe hemolized [destroyed the blood cell] RBC's which caused its contents to come out the cell causing an K increase in that area the K levels in the blood would :. be high, but falsely

Question 29

F&E: hypercalcemia

Answer 29

excess of Ca causes: hyperparathyroidism, immobilization, overuse of calcium products, malignancies tx: loop diuretics [promotes excretion of Ca], fluids, encourage activity, med.'s [d/o cause of condition], low Ca diet, vit. D [helps GI tract absorb Ca]

Question 30

F&E: fluid spacing

Answer 30

1st- normal distribution of body water 2nd- abnormal accumulation in interstitial space [edema] 3rd- fluid is trapped and essentially unavailable and cannot go back to where it came from - it is a distributional shift in fluid in a space that does not easily exchange w. the ECF [i.e. peritonitis]

Question 31

F&E: hypocalcemia

Answer 31

deficit of Ca+ causes: hypoparathyroidism, inadequate vit. D, chronic renal failure s/s: + Trousseau sign, + Chvostek sign tx: IV calcium [regularly check IV bag for calcium precipitation; flush ac and pc Ca administration], Vit. D

Question 32

F&E: trousseaau sign

Answer 32

muscular contraction including flexion of the wrist and metacarpophalangeal joints, hyper-extension of the fingers, and flexion of the thumb on the palm, when a sphygmomanometer cuff is inflating to above systolic pressure for several minutes suggest neuromuscular excitability caused by hypocalcemia

Question 33

F&E: chvostek sign

Answer 33

spasm of the facial muscles elicited by tapping the facial nerve in the region of the parotid gland; seen in tetany and hypocalcemia

Question 34

F&E: tetany

Answer 34

characterized by spasms of the hands and feet, cramps, spasms of the larynx,, and over-active neurological reflexes indicative of hypocalcemia

Question 35

F&E: hypermagnesemia

Answer 35

excess of Mg+ causes: renal failue, excessive Mg+ intake s/s: early [flushing of skin, sense of warmth, N/V] moderate [drowsiness, hypoactive reflexes, weakness] severe [neuromuscular, respiratory and cardiac depression] tx: dialysis [if caused by renal failure], remove source of Mg+, IV Ca+

Question 36

F&E: hypomagnesemia

Answer 36

deficit of Mg+ causes: alcoholism, starvation, diarrhea, increased PTH s/s: hyperactive reflexes, painful muscle contraction, confusion, tetany tx: Mg+ replacement

Question 37

F&E: hypokalemia

Answer 37

deficit of K+ causes: diuretics, poor intake, GI loss, metabolic alkalosis tx: K+ replacement

Question 38

F&E: hyperphosphatemia

Answer 38

excess of P causes: chronic renal failure, excessive intake of phosphorous, hypoparathyroidism s/s: tingling of fingers, muscle spasms, precipitation Ca+ and P - these are symptoms that occur in hypocalcemia b/c Ca+ and P are antagonistic to one another tx: treat underlying disorder, IV Ca+ or hemodialysis [in extreme cases

Question 39

F&E: hypophosphatemia

Answer 39

deficit of P causes: hyperparathyroidism, use of thiazide diuretics s/s: numbness, weakness, decreased cardiac output [decreases O2 perfusion to organs, brain, causing mental changes], mental changes [i.e. apprehension, confusion], acute respiratory failure tx: phosphorous replacement, assess Ca+ levels

Question 40

F&E: CBC diagnostic test

Answer 40

complete blood count measures: WBC, RBC, platelets, Hct [#of RBC: solution], Hmg [# of O2-carrying protein on RBC] - Hct can tell us the hydration status where an elevation indicates dehydration

Question 41

F&E: serum creatinine diagnostic test

Answer 41

tests kidney functioning an increase in creatinine signals liver failure this is the distinguishing factor b/w dehydration and renal failure, if there is an increase in creatinine that indicates kidney dysfunction

Question 42

F&E: BUN diagnostic test

Answer 42

blood urea nitrogen 6-20 mg/dL it is a ratio tell's us the hydration status where an increase signals dehydration and vice versa urea and nitrogen are waste products :. these values tells us about the renal functioning

Question 43

F&E: plasma protein diagnostic test

Answer 43

total proteins: 6.4-8.3 g/dL albumin: 3.5-5.0 g/dL indicated for pt.'s w/ edema [disturbance in colloidal osmotic pressure], in liver dysfunction [liver produces proteins->ascites]

Question 44

F&E: routine urinalysis diagnostic test

Answer 44

tests urine for blood, bacteria, protein, glucose, specific gravity, pH the pH should be fluctuating constantly as the kidneys compensate for disturbances in the acid-base balance, this is a normal finding specific gravity measures urine concentration where an increase signals a concentrated urine

Question 45

PERIOPERATIVE: reasons for surgery

Answer 45

diagnostic curative palliative cosmetic

Question 46

PERIOPERATIVE: urgency of surgery

Answer 46

elective urgent emergent [requires life-saving measures]

Question 47

PERIOPERATIVE: surgery impact

Answer 47

can cause: physical stresses - resistance to infection is lowered - organ function may be altered due to manipulation psychological stresses - fear, pain, anxiety, loss of control, body image, alterations in ADL's

Question 48

PERIOPERATIVE: surgical risk factors

Answer 48

``` age nutritional status fluid and electrolyte balance general health status medications goal: to get the pt. in the most optimal position to handle the surgery to have positive outcomes ```

Question 49

PERIOPERATIVE: legal issues

Answer 49

``` informed consent - regarding surgery, anesthesia, blood - pt. must be >18 y.o. to give consent -- minors may consent to their own surgery if they are emancipated witness to consent - usually the RN's role to be a witness and an advocate for the pt. emergency situations - pt. consent usually isn't obtained ```

Question 50

PERIOPERATIVE: pre-op checklist

Answer 50

``` baseline vital signs provide oral hygiene, remove dentures, record loose teeth [to prevent teeth from dislodging and falling into the throat during surgery remove nail polish, cosmetics, hair pin, protheses have pt. void check name band review consent administer pre-op medications if ordered elevate side rails ```

Question 51

PERIOPERATIVE: pre-op med.'s

Answer 51

anti-anxiety i.e. diazepam [valium] sedative i.e. midazolam [versed] analgesic i.e. morphine sulfate anticholinergic i.e. atropine sulfate - used to decrease oral secretion in event that intubation is needed H2-receptor antagonist i.e. zantac - used to decrease gastric acidity for pt.'s at risk for aspiration to prevent acid from damaging lungs

Question 52

PERIOPERATIVE: members of surgical team

Answer 52

surgeon surgical assistant anesthesiologist or CRNA [certified registered nurse anesthetist] circulating nurse scrub nurse/surgical technologist specialty nurse, or RNFA [registered nurse first assistant]

Question 53

PERIOPERATIVE: intra-operative care

Answer 53

safety positioning - once a pt. is placed under anesthesia, they will remain in the position they are placed in for the entirety of the surgery, it is imp. to prevent permanent damage to the tissues documentation surgical env't. - traffic control, infection control, sterilization of supplies inadvertent hypothermia

Question 54

PERIOPERATIVE: universal protocol

Answer 54

initiated by the joint commission to eliminate surgery at the wrong site, of the wrong procedure, and on the wrong person by: - establishing a pre-op verification process - marking the operative site - performing a "time-out" immediately before starting the procedure

Question 55

PERIOPERATIVE: ASA classifications

Answer 55

``` american society of anesthesiologists classifications ASA 1 healthy 2 one medical problem 3 more than one medical problem 4 severe systemic disease 5 not expected to survive w.o surgery 6 organ harvest ```

Question 56

PERIOPERATIVE: anesthesia induction

Answer 56

it is the point at which anesthesia is initiated just prior to the first incisional cut

Question 57

PERIOPERATIVE: general anesthesia

Answer 57

it produces a controlled loss of consciousness protective reflexes lost via total muscle relaxation can be given intravenously, orally, or through inhalation complications: CNS [emergence delirium, delayed emergence], cardiovascular [hypotension, dysrhythmias, MI], hypothermia, respiratory [laryngospasm], malignant hyperthermia

Question 58

PERIOPERATIVE: malignant hyperthermia

Answer 58

it is a chain of abnormalities that occurs due to an inherited pharmacogenetic disease which degrades skeletal muscle in those w/ disorder, inhaled anesthesia is the trigger [i.e. Halothane, Enflurane, Isoflurane, Desflurane, Sevoflurane, ALL except nitrous oxide] those suspected w/ this disorder have a caffeine/halothane contracture test to confirm dx s/s: early signs [muscle rigidity, tachycardia, dysrythmias], breakdown of muscle->heat->rubor and warmth, tachypnea, pyrexia [Hallmark yet late sign] tx: discontinue anesthesia, administer 100% oxygen, administer dantrelene ASAP, cool pt.

Question 59

PERIOPERATIVE: dermatome chart

Answer 59

they are used to determine the level of block [caused by regional anesthesia] for spinal and epidural access level using a sharp, dull, or cold test items

Question 60

PERIOPERATIVE: postoperative hand-off

Answer 60

``` type and extent of surgical procedure type of anesthesia pt. tolerance of anesthesia and surgical procedure pt.'s allergies pathologic condition status of vital signs type and mount of IV fluids and med.'s administered incisions, dressings, tubes, drains, cathters estimated blood loss [EBL] any intra-operative complications pertinent past medical hx hand off's should be standardized ```

Question 61

PERIOPERATIVE: post-op. respiratory assessment

Answer 61

``` respiratory rate breathing depth and pattern breath sounds pt.'s color use of accessory muscles O2 pulse ox. assess for atelectaasis, pneumonia, embolus - prevent via turning and encouraging to cough and deep breathe - maintain their hydration - ambulate early - encourage use of incentive spirometer ```

Question 62

PERIOPERATIVE: post-op. circulation assessment

Answer 62

vital signs skin temperature peripheral vascular assessment check for bleeding

Question 63

PERIOPERATIVE: pot-op. neurological assessment

Answer 63

ability to obey verbal commands level of consciousness [AAOX3] motor/sensory assessments

Question 64

PERIOPERATIVE: post-op GI assessment

Answer 64

bowel sounds, flatus, B.M. - all of which would have been delayed due to the anesthesia nausea vomiting

Question 65

PERIOPERATIVE: post-op. integumentary assessment

Answer 65

the surgeon ALWAYS cleans the first dressing - should the dressing become saturated in drainage, reinforce w/ additional dressing check for drainage and drains check for proper wound healing

Question 66

PERIOPERATIVE: how to prevent thrombophlebitis

Answer 66

``` leg exercises while in bed early ambulation TED stocking sequential hose avoid pressure that may obstruct flow low dose heparin ```

Question 67

IV therapy: CDC recommendation on sterile principles

Answer 67

IV container should be changed q24h tubing should be changed routinely q48-72h IV site dressing should be changed q48-72h check expiration of tubing, fluids, med.'s, etc. if there is a break in sterile technique, DISCARD AND START OVER

Question 68

IV therapy: factors influencing gravity flow rate

Answer 68

``` height of sol'n. - the higher the sol'n. is placed above the heart, the faster the fluids will drip down patency of cannula venous spasms - due to room temp. [approx. 72o F] med.'s into 98.6o F blood size of cannula bleeding in tubing presence of local complications ```

Question 69

IV therapy: PICC

Answer 69

peripherally inserted central catheters placed in the ante-cubital fossa, fed through the vein and ends at the superior vena cava there are low complication rate and it is less expensive no B.P. or blood draws allowed on the extremity w/ a PICC line

Question 70

IV therapy: CVAD

Answer 70

central venous access device types: tunneled, non-tunneled, port indications: med. administration, nutrition, blood samples/transfusions, conditions [renal failure, burns, chemotherapy] care: x-ray ac starting fluids, sterile dressing change, observe sit for s/s infection or systemic complications complications: catheter occlusion, embolism, infection, pneumothorax, catheter migration

Question 71

IV therapy: infiltration

Answer 71

this occurs when fluid from the IV leaves the bloodstream and invades the deep tissue space this occurrence may not be preventable the after-effects of infiltration can be s/s: pain, swelling, COLD - cold distinguishes infiltration from any other rx that have cause local edema tx: stop IV, pull catheter out, determine whether another IV needs to be put in [based on what med.'s the pt. was receiving

Question 72

IV therapy: phlebitis

Answer 72

it is inflammation of the vessel the catheter is still w/i the vessel and administering sol'n. which is irritating the vessel s/s: warmth, red streak outlining the vessel that is inflamed tx: take catheter out

Question 73

IV therapy: pyrogenic rx

Answer 73

contaminated set-up of IV caused sepsis s/s: abrupt rise in temp., severe chills, shaking, increase in HR and RR, headache tx: stop the IV, KVO [keep vein open] - KVO b.c of vessel constriction and for need to administer emergency med.'s

Question 74

IV therapy: air embolism

Answer 74

air in the line s/s: chest pain, SOB, decrease B.P., increase H.R., cyanosis, anxiety, confusion tx: administer O, place pt. in left-lateral modified tradelenberg [air moves up :. air would move towards feet and away from heart and lungs]

Question 75

IV therapy: circulatory overload

Answer 75

s/s: increase B.P., distended neck veins, S.O.B. | tx: administer diuretic, slow down rate of infusion, increase H.O.B., KVO

Question 76

IV therapy: speed shock

Answer 76

caused by administration of IV push med.'s s/s: dizziness, chest tightness, flushed face, irregular pulse - these can occur in less than a minute

Question 77

IV therapy: hyperal

Answer 77

hyperalimentation is a type of TPN indicated for pt.'s w/ GI disturbances, burns, cancer, malnourishment composed of calories [in dextrose form, electrolytes, protein, vitamins, minerals - individualized for a specific pt.'s needs each day

Question 78

IV therapy: intralipids

Answer 78

it is an isotonic, fat emulsion substance that comes in concentrations of 10-20-30% provides calories in small volumes contains soybean and egg phospholipids the only sol'n. that can be given w/ hyperal s/s pf hypersensitivity rx: tachycardia, N/V, fever, itching, chills contraindicated in pt.'s w/ egg allergies or risk of fat embolism

Question 79

IV therapy: complications of TPN infusions

Answer 79

hyperglycemia - due to the body's inability to get used to the high concentration of dextrose hypoglycemia - due to sudden seizure of TPN infection - due to high concentration of dextrose altered electrolyte, mineral, vitamin balances

Question 80

IV therapy: PCA pumps

Answer 80

enables the pt. to self-administer med. on PRN basis programmed according to medical orders - dosage, time intervals b/w doses, and lock-out intervals] records the amount of med.'s received and the number of requests by the pt. - this assessment, done by the nurse, can be given to the physician w/ intention to alter the order